Ask the Doctor: What causes too much urination at night?

In one night, I wake up more than five times to urinate, which is not the case during the day. Medical tests for diabetes, Urinary Tract Infections as well as sexually Transmitted Diseases have all come back normal. What could be the cause? Anita

Dear Anita,

It is normal for adults to urinate six to seven times in a day, but some may not wake up at all or may wake up once or twice to pass urine at night.

During the day, a person will eat and drink fluids more than at night and this can result in one taking into the body more water which, for proper water balance, may result in one passing a lot more urine during the day. 

To enable one have restful sleep, the brain produces more of a substance called Anti Diuretic Hormone, resulting in reduced urine production as we sleep.

If one passes urine more than twice at night, they may take notice because this usually disturbs sleep. This so called, nocturia is usually caused by the kidney’s overproduction of urine, which can occur when one over drinks fluids including alcohol or caffeine towards bed time, or takes medications referred to as diuretics used to treat pressure. Disease conditions, including diabetes can also lead to too much formation of urine, leading to urinating more at night. 

Much as an enlarged prostate (only found in men) may not cause formation of too much urine, it may lead to failure to empty the bladder properly after urinating, creating a feeling of wanting to pass urine often, even at night. Also, the enlarged prostate may put too much pressure on the urethra and bladder, causing one to feel as though they want to pass urine, even when the bladder is not that full.

Sometimes, one may produce less of the brain hormone (ADH) that reduces production of urine (diabetes insipidus), leading to nocturia. 

Stress and anxiety may also cause, among others, the abdomen muscles to tighten, leading to an increased urge to urinate, especially at night. Therefore, you must consult a doctor who will run tests to confirm nocturia and give proper treatment.

One may reduce the frequency of urination at night by drinking plenty of fluids during the day and limiting them a few hours before going to bed. If one requires taking diuretics, they should be taken in the morning as well as generally avoiding taking caffeine or alcohol, especially at night.

Is a milky discharge normal while pregnant?

I am six months pregnant but have a milky vaginal discharge. After consultation, a doctor prescribed medication which I have been using to no avail. What can I do? Sabina

Dear Sabina,

Candida Albicans, which you may be suffering from, is a yeast usually found on our body parts, including on the mouth, big intestines, in the vagina or even on the penis without causing disease. Under certain conditions or diseases, including those of reduced immunity, diabetes or overuse of antibiotics and pregnancy, candida may overgrow, leading to an infection in the vagina and an itchy discharge that resembles spoilt milk.

For pregnant women, an increase in the hormone oestrogen may create a favourable environment in the vaginal canal, leading to more infection during pregnancy. Also, some women, pregnant or not, are more likely to develop yeast infections due to genetics, which might make them more vulnerable to infections (familial candidiasis).

Although pregnancy itself and inheritance can make it favourable for candida vaginal infections, to recur even after the best treatment, any pregnant woman as a routine or because of recurrent candida should be checked for diabetes, which predisposes one to vaginal candidiasis.

In pregnant women, treatment of vaginal candida infections includes use of antifungal pessaries that are inserted in the vagina and vaginal creams, which are preferred because they minimise drug side effects.

A pregnant woman should trim her nails first and use fingers to insert the pessaries instead of using the inserters or applicators which can risk causing miscarriages in some cases.

Vaginal candidiasis during pregnancy does not affect the foetus though the foetus may be affected during delivery but then given treatment for the same.